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Iliolumbar Artery

arteria iliolumbalis

The iliolumbar artery arises from the posterior division of the internal iliac artery and ascends posterior to the common iliac vessels and the obturator nerve to reach the iliac fossa. It divides into an iliac branch (supplying the iliacus and the iliac bone) and a lumbar branch (anastomosing with the lumbar arteries and supplying the quadratus lumborum and the L5 nerve root). Its ascending course behind the sacroiliac joint makes it relevant in posterior pelvic ring surgery.

Region: Pelvis & Hip

Clinical Relevance

Clinical Notes

The iliolumbar artery is the vessel most commonly injured in posterior pelvic ring fixation and sacroiliac joint approaches: its posterior division origin places it at risk during posterior iliac screw insertion and during posterior approaches to the SI joint. Pre-operative awareness of the iliolumbar artery anatomy on CT reduces the risk of its injury during posterior pelvic ring reconstruction. Selective embolisation of the iliolumbar artery controls bleeding from pelvic fractures involving the posterior iliac wing where direct surgical control is difficult.

Pathology

Common Injuries & Conditions

Iliolumbar Artery Injury in Posterior Pelvic Ring Surgery

The iliolumbar artery ascending posterior to the SI joint is at risk during posterior iliac screw insertion for posterior pelvic ring fixation; inadvertent vessel puncture with the drill or screw produces retroperitoneal haemorrhage in the posterior pelvis that may not be immediately apparent intraoperatively; angiographic embolisation controls bleeding if haemostasis cannot be achieved surgically.